Stefano Civitarese Matteucci, Quadrare il cerchio tra efficienza, qualità e accesso universale alla sanità. La riforma Tory del National Healthcare System inglese


1. Premessa. 
2. Il new public management e il NHS.
3. Privatizzazione, mercato e regolazione.
4. Liberating the NHS?
4.1 La riorganizzazione centrale.
4.2 Le nuove autorità locali con funzioni di committenza e il ruolo dei pazienti.
4.3 La partecipazione dei pazienti e delle comunità locali. 
4.4 La competizione tra i fornitori e le funzioni di regolazione del “mercato sanitario”.
5. Evoluzione o rivoluzione?

This article aims at analyzing and discussing the recent project of reform of the NHS carried out by the British government and passed by the House of Commons in September 2011.The main objectives of the bill had been outlined in the white paper “Equity and Excellence: Liberating the NHS” published by the government in July 2010. According to a large number of commentators, stakeholders and healthcare organizations the bill would completely disrupt the NHS, converting it from a system in which buying and providing services is a duty of the State to a system in which the market assumes this role. Because of this pressure the reform project has been submitted by the government to a special committee of experts (Future Forum), with the task of making an assessment in order to introduce into the bill measures which will guarantee the maintenance of the traditional requisites of NHS: a universal service free at the point of use. After this revision there were changes which affected the initial spirit of the reform. Indeed now it looks like an attempt to bring together some market-oriented elements, such as a wider role of both providers and patients, an enhanced role of GPs as commissioners of clinical services, and the quasi-privatization of hospitals with more typical aspects of public service, such as the duty of every actor of the system to implement the NHS Constitution and the rights enshrined in it.Therefore the article, after commenting on the pros and cons of the reform project, argues that the main teaching of this case study is the extreme difficulty in combining, on the one hand, the objective of improving the efficiency of public bodies and, on the other hand, that of resorting to the market to increase the quality and fairness of public services.